Audit Scotland warns NHS waiting list information ‘poor’
Scotland’s public sector watchdog said it was unable to assert whether NHS waiting list manipulation had taken place, because of “poor” information.
In a small variety of cases, it said patients were inappropriately marked as unavailable for treatment, but couldn’t say whether these were deliberate.
Audit Scotland said the management and scrutiny of the system “had not been ok”.
Health Secretary Alex Neil insisted the issue was “historical”.
Speaking on BBC Radio Scotland’s Good Morning Scotland programme, the minister admitted that IT systems had not been robust enough but that was now changing.
He added that the facility to list patients as “socially unavailable”, thereby removing them from the waiting time system, not existed.
Audit Scotland investigated after waiting list manipulation came to light in NHS Lothian.
They were criticised for removing patients from the 18-week waiting list once they refused to travel to England for treatment, marking them as “unavailable for social reasons”.
It also emerged that some staff at NHS Tayside said they felt stressed to mention patients were “unavailable” for appointments so that it will meet waiting-times targets.
Mr Neil, who made an announcement to the Scottish Parliament at the report, said an internal investigation on the health authority found no evidence of waiting time manipulation or coercion of staff.
The Audit Scotland report – which covered the period when Lothian waiting lists were being manipulated, between April and December 2011 – said there has been “widespread use across Scotland” of the social unavailability patient code during that point.
It said use of the code rose from 11% of patients in 2008 to greater than 30% in mid-2011, which came during a time when waiting time targets were being shortened.
Audit Scotland also said key areas of waiting time systems were inadequate.
It said limited information within the records of patients looking ahead to treatment meant it was not always possible to spot changes or check that status codes were applied appropriately.
The figure started dropping on the end of that year, but Audit Scotland said the cause of this was unclear as a result loss of available information.
“Audit Scotland found a small choice of instances where unavailability codes were used inappropriately,” the watchdog stated.
“Because of the poor information, it was impossible to establish whether these were attributable to human error, inconsistent interpretation of steerage, or deliberate manipulation.”
Scotland’s auditor general, Caroline Gardner, said: “The management and scrutiny of the waiting-list systems haven’t been ok.
“In the course of the period we reviewed, the Scottish government and boards were focussed on ensuring waiting times targets were being met but not giving enough attention to how this was being done.
“Better scrutiny of the increasing use of social unavailability codes can have highlighted concerns earlier. It also may have identified where waiting times pressures were building inside the system.”
Mr Neil said many of the recommendations within the Audit Scotland report were already being implemented.
He told the BBC: “Patients are ok with the waiting times, what we’re unhappy with is – now an historical situation – is the shortcoming of robustness in a few of the IT systems to record the detail of data that we’d like.”
Mr Neil said the social unavailability code was replaced in October by a brand new system giving patients more flexibility to agree once they need to be treated.
The explicit agreement of patients is additionally needed in the event that they want their treatment to be delayed.
The minister has announced that a pilot phone line for patients seeking advice on waiting times might be opened later this year.
The health secretary said work was also under approach to ensure patients knew their rights.
Labour health spokeswoman Jackie Baillie said: “This report makes clear that hidden waiting lists were widespread, not only in Lothian, and the SNP government was aware there has been an issue and did nothing.
“It preferred to believe it’s own spin and hype than concern itself with what was really occurring in our hospitals.”
Scottish Conservative deputy leader Jackson Carlaw added: “Should you have a look at the trends presented here, it’s difficult to arrive another conclusion than the deception utilized by NHS Lothian might was mirrored elsewhere.
“If that is not the case, the Scottish government must explain why there has been any such bizarre rise in patients who became unavailable over a reasonably short time period.”
Liberal Democrat MSP Jim Hume said: “This report takes the gloss off of the SNP government’s record on waiting times targets.
“People across Scotland will find the report’s findings disappointing and unsettling seeing that, earlier than the waiting-times scandal coming to light, as many as 30% of inpatients in Scotland were marked as socially unavailable.”
Iain Gray, convener of Holyrood’s cross-party audit committee, said it might be looking into the flaws raised within the report, adding: “Patient wait times are an incredible NHS performance target and intensely important to the patients themselves.”